Maca T, Mlekusch W, Doweik L, Budinsky A C, Bischof M, Minar E, Schillinger M
Department of Internal Medicine II, Division of Angiology and Endocrinology, Medical University, Vienna, Austria.
Eur J Clin Invest. 2007 Mar;37(3):180-6. doi: 10.1111/j.1365-2362.2007.01747.x.
Diabetes mellitus is a risk factor for early complications and mortality in patients with peripheral artery disease. Lipoprotein (a) [Lp(a)] is also suggested to be a marker of increased cardiovascular risk. We investigated the association and interaction between diabetes mellitus, lipoprotein(a) and mortality in high risk patients with peripheral artery disease (PAD).
We studied 700 consecutive patients [median age 73 years, interquartile range (IQR) 62-80, 393 male (56%)] with PAD from a registry database. Atherothrombotic risk factors (diabetes, smoking, hyperlipidaemia, arterial hypertension) and Lp(a) serum levels were recorded. We used stratified multivariate Cox proportional hazard analyses to assess the mortality risk at a given patient's age with respect to the presence of diabetes and Lp(a) serum levels (in tertiles).
Patients with Lp(a) levels above 36 mg dL(-1) (highest tertile) and insulin-dependent type II diabetes had a 3.01-fold increased adjusted risk for death (95% confidence interval 1.28-6.64, P = 0.011) compared to patients without diabetes or patients with non-insulin-dependent type II diabetes. In patients with Lp(a) serum levels below 36 mg dL(-1) (lower and middle tertile), diabetes mellitus was not associated with an increased risk for death.
Insulin-dependent type II diabetes mellitus seems to be associated with an increased risk for mortality in PAD patients with Lp(a) serum levels above 36 mg dL(-1). PAD patients with non-insulin-dependent type II diabetes, and patients with diabetes and Lp(a) levels below 36 mg dL(-1) showed survival rates comparable to PAD patients without diabetes.
糖尿病是外周动脉疾病患者发生早期并发症和死亡的危险因素。脂蛋白(a)[Lp(a)]也被认为是心血管风险增加的一个标志物。我们研究了外周动脉疾病（PAD）高危患者中糖尿病、脂蛋白(a)与死亡率之间的关联及相互作用。
我们从一个登记数据库中研究了700例连续的PAD患者[中位年龄73岁，四分位间距（IQR）62 - 80，393例男性（56%）]。记录动脉粥样硬化血栓形成危险因素（糖尿病、吸烟、高脂血症、动脉高血压）和Lp(a)血清水平。我们使用分层多变量Cox比例风险分析来评估在给定患者年龄下，糖尿病的存在和Lp(a)血清水平（三分位数）对死亡风险的影响。
与无糖尿病患者或非胰岛素依赖型II型糖尿病患者相比，Lp(a)水平高于36 mg/dL（最高三分位数）且为胰岛素依赖型II型糖尿病的患者调整后的死亡风险增加3.01倍（95%置信区间1.28 - 6.64，P = 0.011）。在Lp(a)血清水平低于36 mg/dL（较低和中间三分位数）的患者中，糖尿病与死亡风险增加无关。
胰岛素依赖型II型糖尿病似乎与Lp(a)血清水平高于36 mg/dL的PAD患者的死亡风险增加有关。非胰岛素依赖型II型糖尿病的PAD患者以及糖尿病且Lp(a)水平低于36 mg/dL的患者的生存率与无糖尿病的PAD患者相当。
